The Impact of Coronavirus Disease 2019 Pandemic on U.S. and Canadian PICUs.

OBJECTIVES: There are limited reports of the impact of the coronavirus disease 2019 pandemic focused on U.S. and Canadian PICUs. This hypothesis-generating report aims to identify the United States and Canadian trends of coronavirus disease 2019 in PICUs. DESIGN AND SETTING: To better understand how the coronavirus disease 2019 pandemic was affecting U.S. and Canadian PICUs, an open voluntary daily data collection process of Canadian and U.S. PICUs was initiated by Virtual Pediatric Systems, LLC (Los Angeles, CA; http://www.myvps.org) in mid-March 2020. Information was made available online to all PICUs wishing to participate. A secondary data collection was performed to follow-up on patients discharged from those PICUs reporting coronavirus disease 2019 positive patients. MEASUREMENTS AND MAIN RESULTS: To date, over 180 PICUs have responded detailing 530 PICU admissions requiring over 3,467 days of PICU care with 30 deaths. The preponderance of cases was in the eastern regions. Twenty-four percent of the patients admitted to the PICUs were over 18 years old. Fourteen percent of admissions were under 2 years old. Nearly 60% of children had comorbidities at admission with the average length of stay increasing by age and by severity of comorbidity. Advanced respiratory support was necessary during 67% of the current days of care, with 69% being conventional mechanical ventilation. CONCLUSIONS: PICUs have been significantly impacted by the pandemic. They have provided care not only for children but also adults. Patients with coronavirus disease 2019 have a high frequency of comorbidities, require longer stays, more ventilatory support than usual PICU admissions. These data suggest several avenues for further exploration.

Acquired Infection and Antimicrobial Utilization During Initial NICU Hospitalization in Infants With Congenital Diaphragmatic Hernia.

BACKGROUND: In addition to substantial medical and surgical intervention, neonates with congenital diaphragmatic hernia often have concurrent concerns for acquired infection. However, few studies focus on infection and corresponding antimicrobial utilization in this population. METHODS: The Children's Hospital Neonatal Database was queried for congenital diaphragmatic hernia infants hospitalized from January 2010 to February 2016. Patient charts were linked to the Pediatric Health Information Systems database. Descriptive clinical data including delivery history, cultures sent, diagnosed infection, antimicrobial use and outcomes were reported. RESULTS: A total of 1085 unique patients were identified after data linkages; 275 (25.3%) were born at <37 weeks' gestation. Bacteremia at delivery (2/1085) and in the first 7 days of life (8/1085) was less common than later infection, but 976 patients (89.9%) were treated with antibiotics. Median number of days on antibiotics was 6 [3,11] for those without a documented infection and 21 [13,36] for those with positive cultures. Incidence of urinary tract infection, bacteremia and pneumonia increased significantly over time and was most common after 28 days. Antibiotic use, conversely, decreased over time (92% of infants in week 1 to 44% in week 4 and beyond). CONCLUSIONS: Although culture positivity increased with age, risk of these selected infections was relatively low for a population in neonatal intensive care unit. An important mismatch is observed between culture negativity and high rates of antibiotic utilization. These data identify opportunities for antibiotic stewardship quality improvement programs.

Effects of a Breast Milk Diet on Enteral Feeding Outcomes of Neonates with Gastrointestinal Disorders.

OBJECTIVE: The objective of this study was to assess whether a diet of ≥50% breast milk (BM) was associated with earlier transition off parenteral nutrition (PN) in neonates with gastrointestinal (GI) disorders. METHODS: This retrospective study assessed enteral feeding outcomes of neonates with surgical GI disorders admitted within the first week of life to a single center between January 1, 2012 and August 10, 2015. Outcomes were assessed according to diet from the point of first enteral intake through 7 days of full enteral feeds. Diets were classified as 100%, ≥50%, or <50% BM. RESULTS: One hundred sixty-three patients with an average gestational age of 36 weeks (range 28-40) and birthweight of 2570 g (range 1250-4900) were included. Significant differences in days to full enteral feeds between the 100% and <50% BM groups were found (median 21 versus 32 days; p = 0.023). There were no significant differences between the 100% and ≥50% BM (p = 0.05) or ≥50% versus <50% BM groups (p = 0.74). The 100% BM group had significantly fewer days on PN compared to the ≥50% BM group (median 21 versus 28.5 days, p = 0.034). Hospital length of stay was significantly shorter in the 100% BM group, which was discharged an average of 10 and 13.5 days sooner than the ≥50% and <50% BM groups (p < 0.05). CONCLUSIONS: Neonates with specific GI disorders who received a 100% BM diet were found to achieve earlier full enteral feeds, have shorter PN courses, and be discharged from the hospital significantly sooner than those who received diets that included formula.